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Is There a Link Between Firefighting and Cancer? – Epidemiology in Action

Epidemiology is the art and science of using data to answer questions about the health of groups. In occupational epidemiology, we use that data to understand how work affects health. This blog entry is part of a series that shares the stories behind the data.

Firefighters face numerous hazards in the line of duty. The risks of acute and potentially fatal injuries and stresses from the dangerous environment of a fire scene are well known. In addition to these hazards, fires generate toxic contaminants, including some agents known or suspected to cause cancer. Less is known about the potential long-term health effects firefighters may experience as a result of work-related exposures. In particular, do firefighters face a higher risk of cancer than is found in the general population?

In 2010, the National Institute for Occupational Safety and Health (NIOSH) embarked on a multi-year effort to conduct a large-scale study to better understand the potential link between firefighting and cancer. The research was a joint effort led by NIOSH researchers and conducted in collaboration with researchers at the National Cancer Institute (NCI) and the University of California at Davis Department of Public Health Sciences and supported, in part, by the U.S Fire Administration.

Higher Cancer Rates

The study found that a combined population of firefighters from three large U.S. cities showed higher-than-expected rates of certain types of cancer than the general U.S. population.

Other notable findings included:

The number of firefighter deaths from all causes did not differ from the expected number of deaths based on death rates in the general population.

The number of cancer diagnoses and cancer-related deaths were greater than that expected based on rates in the U.S. population. The overall excess was comprised mostly of digestive, oral, respiratory, and urinary cancers.

There were about twice as many malignant mesothelioma cases than expected. Occupational exposure to asbestos in firefighting is the most likely explanation for the greater-than-expected incidence.

Some cancers were elevated among firefighters under 65 years of age. For example, firefighters who were under 65 years of age had more bladder and prostate cancers than expected.

Excess bladder cancer risk was evident among women firefighters. However, because bladder cancer is far less likely in women than in men and less than 4% of our study group were women, our results are based on only a few bladder cancer cases.

Methods

Our study method is sometimes referred to as a retrospective longitudinal study, meaning that we followed the health experience of a group of persons over a defined time period beginning at a point in the past. In this case, we studied nearly 30,000 career firefighters from Chicago, Philadelphia, and San Francisco who were employed at any time between 1950 and 2009. Participation by multiple fire departments and inclusion of all firefighters better represents the U.S. fire service as a whole; therefore, our results are generalizable to other firefighter populations. The large study group and lengthy follow-up (sometimes referred to as the observation period) improved our ability to observe rare health outcomes, like most cancers. By including the most recent time period, our study is largely informative on current firefighters; while extending observation to the 1950s allows us to look at temporal trends in risk.

Our study is records-based, meaning that only historical information (e.g., personnel records, death certificates and cancer registry data) comprised the study data. A records-based approach is usually best in retrospective studies of persons who may have relocated or are deceased prior to data collection. This approach also avoids a reliance on the recollection of participants for study data, which can differ among persons and over time.

The health outcomes of primary interest are cancers, although other outcomes were investigated. We examined the numbers of cancer deaths and cancer diagnoses among these firefighters and compared them to “expected” numbers based on rates in the U.S. population. Examining cancer incidence (i.e., diagnoses) in addition to deaths from cancer is preferable when assessing risks of cancers that tend to have higher survival rates, such as testicular, bladder, breast, and prostate cancers.

What’s Next?

These findings add to a growing body of scientific evidence suggesting a cause-and-effect relationship between work-related exposures and cancer in firefighters. Our next steps will further investigate cause and effect by examining the relationship between “exposure” and cancer among these firefighters. Workplace exposures will be estimated from employment records of fire runs and station assignments.

Raised awareness and exposure prevention efforts are cost-effective means to reduce occupational cancer risk. Thus, the fire service should increase efforts to educate members about safe work practices. This includes proper training, proper use of protective clothing, and proper use of approved respiratory protection during all phases of fire fighting.

16 comments on “Is There a Link Between Firefighting and Cancer? – Epidemiology in Action”

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Thank you Dr. Daniels! The information you provided validates our fire department’s actions regarding protecting our firefighters from the toxic and carcinogenic affects of smoke found at “every” fire. I am with a career fire department in Colorado and we have been working on fire ground procedures to monitor atmospheric conditions on the fire ground including the command post and our rehabilitation location. Our firefighters are wearing SCBA sooner and longer than past practice. We also recognize the ability of some of these chemicals to be absorbed into the body and recommend all firefighters remove PPE as soon as possible. Our fire department is fortunate to provide a second set of bunker gear for our personnel so we can wash our gear after every fire. We also recommend firefighters to take a shower as soon as they return to the station.

Other actions we are considering are to provide gross decontamination at the fire scene to remove soot, ash and other products of combustion specifically for fire crews who are involved in offensive interior firefighting and overhaul operations.

As a firefigher in the last third of my career I believe We, The Fire Service, have an obligation to educate and train our personnel on how to better protect themselves from our inherent occupational risks of cancer.

It’s interesting to me that there were no lung cancer studies. Taking in smoke in that way can dramatically increase the body’s ability to detoxify the body effectively. Also it would stand to reason that toxins ingested would impair immune function and organ function. I suspect that there are lots of other professions where people are at risk for cancer like airplane pilots. Thanks for doing this kind of research and sharing this information.

How would fire departments protect fireman from these environmental toxins?

Dr. Daniels thank you for the information provided on cancer. I am really thank full for this i am looking for this information around. Your information is help full in submitting thesis for my subject on cancer in SCRA

Helping people is a kind noble, espescially as a firefighter which will have many risks on their duties. They have to be careful in their step in case of the danger might be caused by the fire. This information is very helpful, thanks a lot Dr. Daniels.

Dr. Daniels thank you and you colleagues for delving into this problem. As we move to reduce the cancer rates among first responders, I offer this; fire fighters and fire investigators are notorious for removing their SCBA during late stage overhaul, and the process of determining point of origin and cause. As a dedicated Safety Officer, I continue to caution against this bad habit. My simple explanation, solid particulate matter that is airborne, post fire extinguishment. This is evident when looking into a light beam or beam of a flash light.

Thank you for your efforts. I just lost my 28 yo son in less than one week to a GBM grade IV situated in the cerebellum; a rare location for this tumor in patients less than 30 years of age. He was a rescue diver and Fire Rescue Boat pilot but prior to that was assigned to a firestation with a known association of neoplasms in both active duty and retired personnel. I am currently in severe mourning but am trying to refocus to address issues in the City of (name removed) FD where it was only recently they were allocated an extra hood to wear under their helmets, but still have only one set of bunker gear and no professional decontaminant protocol with proven efficacy being employed. My son’s “decontamination” following exposure dives in the Miami River (polluted body of water) was a “shower” at the station. If you could reach out to me as a fellow health care provider as I have followed all links to the major studies but I would like to present data to admionistrators and commissioners so as to implement protocols now not years later so young men and women may avoid if possible catastrophes from unnecessary risks and just worry about the necessary risks of their vocation–fires, accidents, trauma, earthquakes, what have you, etc… Thank you.

Great, Thanks for the informative information about cancer. It’s really helped me a lot of knowledge to know lot more about it. I was glad that i read your article, it’s good to read. Thank you for sharing it.

Thank you so much for the information. My husband was a volunteer firefighter for 15 years here in Indiana. We are currently working on an appeal to link his cancer to his firefighting service. He was diagnosed in July 201 2 with Antiplastic Oligoastrocytoma at the age of 38. One particular fire sticks out in our minds as a major contributor to his cancer. It was a major tire fire that lasted for several days.

We have now started our own cancer organization for our volunteer firefighters here in Indiana to help them to understand that they have to be safe and not only wear their gear properly, but to clean it properly so that it will continue to protect them.

Has someone thought of a decontamination spray shower as soon as firefighters are ready to leave the scene-from the back of the truck so that the inside of the cab and persons would not be “wearing” and risking touching the chemicals on the surfaces of the gear. Then back at fire station, a strip and total shower and change.

I thought of this because I was a civilian working on an army base (an nurse practitioner) and we were trained in chemical warfare decontamination in the field.
Rebecca
Virginia

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